Get access

Sleep-Disordered Breathing and Cognition in Older Women

Authors

  • Adam P. Spira PhD,

    1. From the *Department of Medicine, Division of Geriatrics, and Departments of ††Psychiatry, ‡‡Neurology, and §§Epidemiology, University of California at San Francisco, San Francisco, CaliforniaSan Francisco Veterans Affairs Medical Center, San Francisco, California;California Pacific Medical Center Research Institute, San Francisco, California§Department of Pediatrics, Case Western Reserve University, Cleveland, OhioDepartment of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania#Department of Psychiatry, University of California, San Diego, California**Veterans Affairs San Diego Healthcare System, SanDiego, California.
    Search for more papers by this author
  • Terri Blackwell MA,

    1. From the *Department of Medicine, Division of Geriatrics, and Departments of ††Psychiatry, ‡‡Neurology, and §§Epidemiology, University of California at San Francisco, San Francisco, CaliforniaSan Francisco Veterans Affairs Medical Center, San Francisco, California;California Pacific Medical Center Research Institute, San Francisco, California§Department of Pediatrics, Case Western Reserve University, Cleveland, OhioDepartment of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania#Department of Psychiatry, University of California, San Diego, California**Veterans Affairs San Diego Healthcare System, SanDiego, California.
    Search for more papers by this author
  • Katie L. Stone PhD,

    1. From the *Department of Medicine, Division of Geriatrics, and Departments of ††Psychiatry, ‡‡Neurology, and §§Epidemiology, University of California at San Francisco, San Francisco, CaliforniaSan Francisco Veterans Affairs Medical Center, San Francisco, California;California Pacific Medical Center Research Institute, San Francisco, California§Department of Pediatrics, Case Western Reserve University, Cleveland, OhioDepartment of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania#Department of Psychiatry, University of California, San Diego, California**Veterans Affairs San Diego Healthcare System, SanDiego, California.
    Search for more papers by this author
  • Susan Redline MD,

    1. From the *Department of Medicine, Division of Geriatrics, and Departments of ††Psychiatry, ‡‡Neurology, and §§Epidemiology, University of California at San Francisco, San Francisco, CaliforniaSan Francisco Veterans Affairs Medical Center, San Francisco, California;California Pacific Medical Center Research Institute, San Francisco, California§Department of Pediatrics, Case Western Reserve University, Cleveland, OhioDepartment of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania#Department of Psychiatry, University of California, San Diego, California**Veterans Affairs San Diego Healthcare System, SanDiego, California.
    Search for more papers by this author
  • Jane A. Cauley DrPH,

    1. From the *Department of Medicine, Division of Geriatrics, and Departments of ††Psychiatry, ‡‡Neurology, and §§Epidemiology, University of California at San Francisco, San Francisco, CaliforniaSan Francisco Veterans Affairs Medical Center, San Francisco, California;California Pacific Medical Center Research Institute, San Francisco, California§Department of Pediatrics, Case Western Reserve University, Cleveland, OhioDepartment of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania#Department of Psychiatry, University of California, San Diego, California**Veterans Affairs San Diego Healthcare System, SanDiego, California.
    Search for more papers by this author
  • Sonia Ancoli-Israel PhD,

    1. From the *Department of Medicine, Division of Geriatrics, and Departments of ††Psychiatry, ‡‡Neurology, and §§Epidemiology, University of California at San Francisco, San Francisco, CaliforniaSan Francisco Veterans Affairs Medical Center, San Francisco, California;California Pacific Medical Center Research Institute, San Francisco, California§Department of Pediatrics, Case Western Reserve University, Cleveland, OhioDepartment of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania#Department of Psychiatry, University of California, San Diego, California**Veterans Affairs San Diego Healthcare System, SanDiego, California.
    Search for more papers by this author
  • Kristine Yaffe MD

    1. From the *Department of Medicine, Division of Geriatrics, and Departments of ††Psychiatry, ‡‡Neurology, and §§Epidemiology, University of California at San Francisco, San Francisco, CaliforniaSan Francisco Veterans Affairs Medical Center, San Francisco, California;California Pacific Medical Center Research Institute, San Francisco, California§Department of Pediatrics, Case Western Reserve University, Cleveland, OhioDepartment of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania#Department of Psychiatry, University of California, San Diego, California**Veterans Affairs San Diego Healthcare System, SanDiego, California.
    Search for more papers by this author

  • This study was presented as a poster at the 20th meeting of the American Association for Geriatric Psychiatry, March 2007, New Orleans, Louisiana.

Address correspondence to Adam P. Spira, PhD, 4150 Clement Street 181-G, San Francisco, CA 94121. E-mail: adam.spira@ucsf.edu

Abstract

OBJECTIVES: To investigate the association between objectively measured sleep-disordered breathing (SDB) and cognitive impairment in community-dwelling older women and to determine whether the apolipoprotein E (APOE) ɛ4 allele modifies this association.

DESIGN: Cross-sectional.

SETTING: Participants' homes and two sites of the Study of Osteoporotic Fractures (SOF).

PARTICIPANTS: Four hundred forty-eight women with a mean age±standard deviation (SD) of 82.8±3.4.

MEASUREMENTS: Participants completed the Mini-Mental State Examination (MMSE), Trail Making Test Part B (Trails B), and polysomnography (PSG). SDB indices were the apnea–hypopnea index (AHI), the central apnea index (CAI), and oxygen saturation (SaO2) nadir less than 80%. APOE ɛ4 was determined for a subset of 242 women. Cognitive impairment was defined as 1.5 SDs or more from the sample mean on either cognitive test (MMSE or Trails B).

RESULTS: All SDB indices were associated with cognitive impairment according to the MMSE (AHI (per SD, odds ratio (OR)=1.4, 95% confidence interval (CI)=1.03–1.9), AHI of ≥30 (OR=3.4, 95% CI=1.4–8.1), SaO2 nadir <80% (OR=2.7, 95% CI=1.1–6.6), and CAI (per SD, OR=1.4, 95% CI=1.1–1.7)). Weaker, nonsignificant associations emerged between SDB and Trails B. In women who completed genotyping, each SD increase in AHI was associated with 70% greater odds of cognitive impairment according to the MMSE (OR=1.7, 95% CI=1.2–2.6). Women with the ɛ4 allele had a nearly five times greater odds of impairment (per SD, OR=4.6, 95% CI-1.0–20.7); the association was smaller and nonsignificant in women without the ɛ4 allele (per SD, OR=1.5, 95% CI-0.9–2.4; P for interaction=.08).

CONCLUSION: SDB is an important risk factor for cognitive impairment in older women, especially those with the APOE ɛ4 allele. Mechanisms linking these disorders need to be identified.

Get access to the full text of this article

Ancillary